Effects of different postoperative rehabilitation approaches following shoulder arthroplasty: A systematic review and meta-analysis.
TL;DR
In reverse total shoulder arthroplasty (rTSA), home-based rehabilitation was non-inferior to outpatient physical therapy for range of motion, patient-reported outcomes, and pain at 1 year and current evidence is insufficient to recommend subscapularis-specific training.
Abstract
Background The optimal postoperative rehabilitation protocol after shoulder arthroplasty remains unclear. This systematic review and meta-analysis of randomized controlled trials (RCTs) aimed to compare the effectiveness of different rehabilitation interventions. Methods Two reviewers independently screened studies, extracted data, and assessed risk of bias using the PEDro scale and RoB 2 tool. Meta-analysis was performed with a random-effects model. Results Nine RCTs (793 patients) were included; PEDro scores ranged from 5 to 8. In reverse total shoulder arthroplasty (rTSA), home-based rehabilitation was non-inferior to outpatient physical therapy for range of motion, patient-reported outcomes, and pain at 1 year. Early mobilization improved forward flexion at 3 months, but this difference was no longer evident at 6 months; in one anatomic TSA trial, it was associated with a trend toward lower lesser tuberosity healing. Subscapularis-specific training did not confer additional benefits. Discussion Home-based or telerehabilitation is a safe, potentially cost-effective alternative after rTSA; limited evidence for anatomic TSA suggests similar trends. Early mobilization offers transient functional gains, and current evidence is insufficient to recommend subscapularis-specific training. These findings highlight the need for further high-quality trials, especially in anatomic TSA.